Gastric Adenocarcinoma Presents as Gastrocolic Fistula and Perforation

A 65-year-old man one year post neoadjuvant treatment for rectal adenocarcinoma in the lower rectum presented with severe abdominal pain and a two week history of watery diarrhea. An abdominal CT showed free air under the diaphragm with a suspected gastrocolic fistula. In the operating theatre, an exploratory laparotomy revealed cloudy fluid with pus and perforation of the transverse colon with a large mass invading the greater curvature of the stomach from the antrum into the transverse colon. A distal gastrectomy, extended right hemicolectomy, gastrojejunostomy, and end ileostomy were performed to excise the mass and the perforated area.